Question of the Month – Mar 2013

This question is going to have multiple parts. Did you have a weight issue in relation to your thyroid condition? Did you lose weight, once you started medication? What things have you tried to help with weight loss? What worked and what didn’t? Do you have other conditions that may exacerbate the problem? Those could include insulin resistance, PCOS, or others.

We all have our difficulties when it comes to dealing with thyroid issues; sometimes these difficulties can be overwhelming and I don’t know about everyone else, I often spend hours and hours, searching the internet trying to find answers to my questions. Sometimes, I’m successful in finding answers, other times, I’m not.

One of the biggest issues I’ve had since developing Hashimoto’s/hypothyroidism is weight gain and the inability to lose weight. While doctors will often tell us that thyroid malfunction typically only causes a 5-15 lb weight increase, many of us know that’s not true, as we’ve seen for ourselves that it’s possible to gain much more. They also tell us that once we start taking thyroid replacement the weight will come off; again, some of us see, every time we look in the mirror, that, too, is not always true. For some, the weight falls off, others have to make it a life’s work, practically, to get the weight off.

There are no right or wrong answers to the questions; the questions are for discussion, as we’d like to know what has been tried, what has worked and what hasn’t worked. We’re all individuals, so we know that what works for one, won’t necessarily work for another.

Here's an update........ had a doctor's appointment this week, and have now been diagnosed with metabolic syndrome. In my case, it's a combination of insulin resistance/pre-diabetes, high blood pressure and high triglycerides.

Add my hypothyroidism and you might understand how weight loss will be difficult

During a time when I had gotten back into hypothyroidism, when Armour Thyroid was not available and I was dependent on T4 meds only, I gained about 28 pounds over a span of about 9 months. Since I was not converting the T4 adequately to T3, my Free T3 level was in the lower third of the range, as I remember. As soon as Armour was again available, I switched back and after some tweaking of dosage, with the blood draw for testing done before taking my daily meds, my Free T3 was 3.9 (range of 2.3 - 4.2) and Free T4 was .98 (range of .60 - 1.50). Over the next 8 months I lost all the 28 pounds, without making any other change.

Each person has an expected resting metabolic rate dependent on their gender, weight, height, and age. When you are hypothyroid, the actual metabolic rate may be significantly lower than the expected level. This makes it difficult to impossible to lose weight and keep it off. So getting thyroid levels right, can return your resting metabolic rate to normal, and allow you to get to the weight that is "normal" for you, taking into consideration your dietary and exercise habits.

Yes, we always figure that getting thyroid levels right, should return metabolic rate back to normal, and I thought I was going to be one of the those lucky ones, too; unfortunately, that doesn't always work for everyone, when you add in other factors, such as the insulin resistance.

Insulin is often referred to as a "fat storage" hormone, so the higher the blood sugar goes, the more insulin is pumped out and the more fat gets shoved into the cells.

From http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Triglycerides_UCM_306029_Article.jsp

"Calories ingested in a meal and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body's needs for energy between meals." Unfortunately, it doesn't say which hormones. Another subject for research.

All of these things have to work in conjunction with each other and when one or more parts of the process, don't work, steps have to be taken to get them all back in line, not just one part of the equation.

My thyroid levels are already good, so over the next few months, my "job" will be to keep blood sugar in check, in order to keep insulin levels lower, as well as getting plenty of exercise to get triglyceride levels down.

I'll go for a metabolic study next week; will be interesting to see how it turns out.

Thanks Barb, I loved this "question of the month" post. I hope more members shared their experience, it would be very helpful for all of us who are in replacement thyroid medicine.

In my case it has been 5 to 15 pounds and when I started to take medicine it started to come off. But for me any minimal hormonal imbalance affects my weight. If I start taking or go off birth control pill for example, then my weight goes up and down, depending of who knows what.

I have anxiety also and I think that thyroid replacement and other supplements (vitamins and minerals) have helped me to stabilize that anxiety that ultimately makes me want to eat when I am not hungry or when I should not be eating!!

For me, a good diet, well balanced hormones and exercise make the trick in keeping my weight where I want it to be. I am more concerned now that I am older in having a healthy weight which means to me, to have nutritional foods: low sugar, lots of protein, and low carbs.

I dance, I do yoga, I run, I walk, and I lift weights as part of my routine. But if my hormones (thyroid, and reproductive) are a mess, then it is harder to lose the weight.

I think that we forget sometimes that for us women it is more challenging since we have to deal with progesterone, estrogen and testosterone, among others (to balance them) besides our thyroid condition.

You seem to be a "textbook" case as far as the weight issue is concerned.

I guess I don't spend enough time with the diet/exercise issue; always seem to be on the go as it is and often wonder how to make time to add in more. I'm looking forward to my metabolic workup on Tues...... I'm sure that will be a real eye-opener.

I do appreciate your post; it's nice to know that what "should" happen, really does, in some cases.

I, too, hope others will post their experience. We've had a lot of inquiry into this issue, so we know it isn't new.

Way back in 1999 - 2000 i was gaining weight rapidly, depsite trying to exercise and watching what I ate. After 1 year of trying to find out what was wrong (I figured either I was eating in my sleep - not likely 'cause I was so fatigued I literally slept like the dead, or there was something wrong), I was finally diagnosed with being hypothyroid and PCOS. I was on synthetic thyroid hromone first, whcih helped but wasn't the whole answer. With exercise and still watching diet and took up triathlon I slowly lost 35 lbs over about a year. Later I started on dessicated thyroid (ERFA) and it really helped. Since then weight loss is still a major challenge, but compared to premedication days is easier.

I know that I have to work harder than 'most' people to lose weight. Most successful for me is very low carb, calorie restriction, plus exercise.

I have also gone on to develop diabetes in 2008 (early when pregnant with my first), and this never went away. I use insulin rather than oral meds to try to have 'excellent' control, even though I do still have some of my own insulin production happening.

I am still heavieer than I want to be. About 15 kg above my target of 65 kg. I am now nearly 12 months post baby no. 2 and am increasing exercise to try to get things moving. My thyroid levels were a bit low, so I've also slightly increased my meds and hopefully this will help too.

I can only comment about my wife who is hypo. She has found it virtually and totally impossible to lose weight despite diet and considerable exercise.

The routine is that when she starts out on this diet and excise program in the first week or maybe two weeks she loses about 10 lbs. Then no matter what or for how long she continues the diet and exercise it get NOTHING. And I mean NOTHING additional lost. At one point she continued on this for I think 12 or more weeks and never lost or varied more than a single pound which could be just water.

Now saying this also we do not believe she has ever been fully optimized for medication and we're now working with a new Endo who started her on a T3 med which made her feel a bit better but refuses to change the dosage to increase even after 3 months and her initial labs show her FT3 and FT4 dropping a little over that time and her symptoms coming back. So this is a frustrating process.

As a result my wife does not have a very good attitude, poor body image and thus self esteem and is generally "bummed out" because while she wants to lose weight she knows and has proven to herself that it is impossible about 10 different times over they years. So now she is in the wait and see what the heck this new Endo will do. If she ever gets optimized in Thyroid maybe then she'll try again to lose weight. But up until then it is just a waste of time and does nothing but increase depressed attitude at working so hard and getting ZERO results.

I am not sure how much of my weight gain is due to hypothyroidism, but I do think the difficulty in taking it off is related. I gained about 10 pounds per year for four years and stayed steady at that weight for about 18 months. Then I lost about five pounds not really doing anything differently. When I was gaining, my routine blood work was always normal. At the time I started gaining, I was fairly lightweight (100# 5'5") so 15 pounds was ok, the other 25, not so much. As I said, I did lose five pounds and would like to lose 15-20 more. I am hoping as my levels get in a more appropriate range that I can see some positive weight loss results. For me, age is certainly a factor. I'm not *that* old, but am nearing menopause. As hormones shifts, where I carry the weight is shifting a bit. Everything in moderation, right? I do enjoy good food and good wine. I don't mind being a little softer than in the past, but would like to lose just a little. If my thyroid is responsible to some degree, I am hopeful that some weight might come off. We shall see.

Haven't had a chance to get back here and look at this thread; happy to see additional posts.

I guess it's fairly normal for us women to start gaining weight sometime in our 40's, though I did very well until my thyroid "wigged" at about age 58 and from there, things went downhill in a hand basket.

Like you, courtney, I didn't worry too much about the first few pounds, because I was well within a healthy weight range. As my weight continued to go up, though, and nothing I was doing seemed to matter, I became concerned. I started out gaining a pound or two at a time, but then, it started going in 5-10 pound increments and it seemed there was nothing I could do to stop it.

Of course when we gain/lose weight very quickly, we can usually figure that a good share of it is water weight and one of the first hypo symptoms that went away was the bags under my eyes and I did drop a few pounds, only to regain them, down the road.... it's been that way every since. I think I lost and gained the same 10 pounds every week for a couple of years until my weight finally started creeping up and I haven't been able to get it back down.

Of course, we know that we have to either take in less calories or use up more, in order to lose weight. Just this week, I've started on a new program to try to get/keep insulin levels more steady, control calories and because I have low protein levels, which causes excess water weight, loss of muscle mass, etc, my program includes a lot of extra protein in the form of shakes, etc.

Additionally, even though my neighbor and I walk every morning for at least an hour (our route is right at 3 miles), my weight doesn't budge. My "coach" says (and I knew this, just hadn't thought about it for a while)...... I do the 3 miles every day; my body is used to it and just assumes that's the exercise I'm going to get........ the trick is change it around.... add more distance/time, intensity, new exercises, etc......I'll continue my morning walks, but plan to try to increase them, plus I've just started a line dance class and now have a brand new zumba dvd....... I'm also trying to come up with enough time to add back in some yoga.... good thing I'm retired or I'd never have time for all this...... lol

I was diagnosed hypERthyroid, Grave's Disease, 4 1/2 years ago. But don't hate me, I'm one of the small percentage of hyper patients that gains weight. I was 32 years old, 5'2", and had gained about 10lbs, to put me at 135lbs. I had, since my teens, been around 125lbs, give or take a few pounds. Once I started treatment, methimazole, I gained 60lbs in 4 months! Yes, that's alot, at 5'2" that put me as obese. Dr said I would have to wait for my weight to level out, it could take a couple years. Devastating!

Fast forward, a year and a half ago. My thyroid levels were under control, I had stopped medication, and was in remission. Time to try to lose the weight. I was able to lose 40lbs in 5 1/2 months, but it was HARD!! 500-1300 calories a day, had to change it up every few days or I would plateau. Also, at LEAST 3 hours exercise a day, EVERY day. Treadmill, weight lifting, zumba, step aerobics, running, pilates. I was obsessive about trying to get the weight off and had little time for anything else. I was still a little over weight, but could finally breathe while tying my shoes- so I was pretty happy!! I decided to take the summer 'off.' Which means digging and building a fence, group runs, hikes, etc-definately still exercise. I also tried to eat healthier, fresh summer foods, but did not count calories, weigh food, or deny myself the occasional treat.

By October....ALL the weight was back!! Not more, just back to my 60 extra lbs. All that time and effort for nothing. I felt utterly defeated. Sure I could start all over and take all that time and effort, and act like a crazy compulsive person, to lose it again, but then what? Gain every ounce back? I never had a weight problem before, I am now 37 years old and still in remission. My thyroid tests are normal. But once again I cannot breathe and tie my shoes at the same time, more than a little humiliating!

I'm not sure if anyone has any advice, although I hope someone does. If nothing else, maybe someone will stumble across this and realize they are not alone. Weight gain issues can and DO happen to hyperthyroid people too....

I am glad I saw this question of the month. I have mainly been lurking on these boards for almost 4 years now. I have posted a few questions during that time and been given some wonderful information by the most amazing people on here. When I first started having thyroid issues I lost weight, about 32 lbs. but that was because I was really sick with my thyroid. I was ver hyper and I chaulk the weightloss up to that. Since the RAI treatment of my thyroid, I have gained back all but about 10 lbs of that 32 lb weight loss. I am considered obese, and would be completely happy to lose just 30 lbs which would get me just below the 200 mark. Unfortunately for me, weight loss is like pulling teeth. Actually, it's harder than that. I feel like flying fools wife that can limit my carb, sugar, fat intake and lose 10 lbs and that's it. I get discouraged with it because I want to see results from the efforts and the hard work, and it just doesn't happen. Right now, I recently started the "17 day diet" after hearing about it from a friend. Basically, it's a healthier version of Atkins, so we'll see how things turn out after the first 17 days. I know that I am not alone in this battle, this board is proof enough of that. I guess if we just keep on keepin' on maybe eventually something will change with the weight loss. I keep hoping that anyway.

My severe insulin resistance is causing my fat to stick to me like glue. I am going to try Cinnamon and Green Coffee Bean Extract to help with glucose surges after eating. If you have time to spare, check out the video presentation: The Food Revolution - AHS 2011. Amazing!

This is my experience as well. I tried Synthroid first, heard that T3 would make me feel better, tried Armour next and then was concerned about the fluctuations in the amount of hormone contained and the ack of consistecy in the natural pig thyroid. Was convinced to go back on Synthroid and have been trying for 8 weeks to lose weight. I weigh 186 lbs. always. At 5' 4" I want to lose 40 lbs, but nomatter ho hard I work at the gym (4x a week on a treadmill with my heartrate consistently at 120 for 40 minutes each day) and eating almost no carbs- I still stay the same. The only time I lost weight at all was when I fasted completely for 3 days. Then I lost 5 lbs. Other than that I don't lose any. I went to the endo today and she changed my med to Tirosint which I am supposed to begin tomorrow. Not really hopeful after all the negative posts I've read. If I ever get my libido back I don't want to be bald at the same time. A month after this trial, I will be trying to *** Cytomel for awhile to see if I feel better.

I know I'm a bit late coming to the party...it's almost April...but I have a question for most of you. How many of you ever lost a substantial amount of weight (while TRYING to) BEFORE you were hypo? I'm not talking about the 5 or so pounds that you gained over the holidays and took off by cutting out desserts/alcohol/whatever for a week or two and were back to your usual weight. I'm talking about losing the kind of weight we typically gain while hypo, say 30+ lbs (yeah, Barb, 10-15#...my left hind foot!).

I ask because I've had a weight issue all my life, which I was mostly successful at controlling, but I always said that my body had no vested interest in stasis...if I wasn't losing, I was gaining. This was years before hypo.

After starting thyroid meds, I dropped 25# in a couple of months while doing nothing differently. My lower extremities had been terribly swollen while hypo, so we can probably assume most of that was water. After that, the most amazing thing happened that had never happened to me in my life...I stayed at that weight, even dropped a few (very) lbs now and then. That has continued for years now.

I am so thrilled to not be gaining any longer that I haven't even tried to take off any more weight, so I really have no experience with weight loss after hypo diagnosis (part of the reason I didn't comment on this thread earlier).

So, maintaining is one thing, and losing is another. Now, to me, it stands to reason that if you gained weight while hypo, once you are euthyroid, you can expect to maintain, but in order to lose weight, you might have to be equally hypER for a while (not desirable) or actually make an effort.

My experience in weight loss is that it is INCREDIBLY difficult, and I sometimes wonder if people who never had a weight issue before hypo simply have very little appreciation for how hard it is.

A few observations, some of which fly in the face of what's considered "healthy" (but so does an extra 35-40 lbs) and will never be recommended by your dietician:

1) I always found that if I ate 1000-1200 calories per day, I lost NOTHING, not more slowly, nothing. I had to cut calories to 750-1000. I think there's a "magic" number we all have to find, much like where our thyroid hormone levels have to be where we start dropping weight.

2) Adding exercise alone never did anything for me...I had to combine exercise and diet. I limited exercise to a half hour a day. I think it's important to do it every day because there's a residual increase in metabolism even after the exercise is finished. However, I'm not sure that from a weight loss point a view, more is better. If you do more than you can sustain for the rest of your life, you are going to start gaining when you lower exercise levels.

3) It always took my body a while to get into "weight loss mode", i.e. I had a harder time losing at the beginning of a program that at the end.

4) I had to weigh food and count calories until I got to the point where I could (honestly) weigh it with my eyes. I had to read labels and pay particular attention to serving size.

5) NO cheating. Cheating (and I did VERY little) could set me back with an initial gain due to the cheat and no weight loss for two weeks. "My" definition of cheating: eating out, "rewards" for being good all week, going to parties (yep, this will ruin your social life), alcohol, etc.

Ignoring other possible contributors for a moment, obviously if your caloric input ( calories eaten minus calories burned with extra exercise) exceeds your BMR, then you gain weight. Also assuming that a person has not found a way to gain height, or reduce age, LOL then for every 10 pounds a woman loses, her BMR drops about 45 calories per day.

So when overweight due to low metabolism due to low thyroid, when thyroid levels are corrected, there should be a weight reduction to account for that. Goolarra mentioned it, and I had the same result. I lost faster at the beginning, and then slowed, since my actual metabolic rate would have been dropping due to the weight loss. Per the formula, for men, every 10 pounds lost drops the actual metabolic rate by about 62 calories per day

I also want to mention is that I have read that low carb diets, like the Atkins diet, will work for many people, but it is difficult to maintain the diet and also over time it actually seems to cause the body to increase the rate of conversion of T4 to Reverse T3. Obviously this is not a desirable result.

Some members might also find it interesting that a former member having metabolism and weight problems, along with other hypo symptoms, could not get her doctor to prescribe thyroid meds, because of course her test results were in the "normal" range. So she got a BMR test and this is her story from there.

"I was having some major problems with my metabolism. I am a nurse and I thoroughly researched all the scientific research on the internet and at the medical library. I, too was going to see doctors who would not help me. Fortunately, I found a doctor who gave me Armour Thyroid despite "normal" levels. I brought him a BMR test that showed my BMR in 750-900 range which is very low, I was cold all the time. I was fatigued. When you have to get in the tub 2-3 times a day to warm up your body, you got a problem I have fake nails and suddenly I wasn't needing to go as normally to have them filled they had really slowed in growth. I put together my own research on my body. I started taking the medication as prescribed and he adjusted accordingly until I was free of symptoms. I documented all the thyroid lab work before and after treatment. I went and had metabolic testing to test my BMR and it measured normal for my age and weight and I was symptom free. I then tapered myself off the thyroid and within 2 months all symptoms returned and metabolic testing once again was done, and BMR was extremely low. Back on meds. normal. You know your body best and I am not afraid to put the research in front of a doctor's face. The human body is not black and white."

"So when overweight due to low metabolism due to low thyroid, when thyroid levels are corrected, there should be a weight reduction to account for that."

I tend to disagree with that both from experience and from a mathematical/psychological (there's a combo for you!) point of view. LOL

Yes, I lost 25 lbs after starting meds, but it came off so fast and so easily that I have to assume it was mostly water, i.e. not real fat loss. Since then maintenance has been a breeze, but I have lost little further weight (haven't tried, either).

Mathematically/psychologically, I don't think it washes, either. Example: Say I weigh 150 lbs, and should eat 1500 calories per day to maintain my weight. I'm hypo, and while maintaining a 1500 calorie diet, I balloon up to 180 lbs, where I need roughly 1800 calories per day to maintain. I become euthyroid. My metabolism goes back to "normal". However, I religiously stick to my 1500 calorie diet. So, all other things being equal, I "save" 300 calories a day. You have to save 3600 to lose a pound, so that would be one lb every 12 days (360 days to lose the 30 lbs).

However, as gimel pointed out, the closer I get to my goal of 150 lbs, the more the returns diminish. At 170, I'm now only saving 200 calories per day, and it will take me 18 days to lose a lb. At, 160 it will take 36 days to lose a lb. Cheat a little, and it's all over but the crying. That's MUCH too slow, even at the beginning to inspire most people and maintain their interest in the program...it's closer to torture actually! So, the closer you get to your goal, the more you have to reduce calorie intake, i.e. you HAVE to do things differently.

I might point out that theoretically, that last lb would take you 360 days to lose.

Sorry if I wasn't clear, but I always had a hard time jump starting a diet at the beginning. I don't have any idea why, but it always took me a while to convince my body that we were in "weight loss mode". I've always tried for 2 lbs per week loss, and at first I have a hard time achieving it. Later in the program, I sometimes have 2.5-3 lbs dropping in a week. Makes no sense, whatsoever, I agree, but it happens to me all the time...maybe I just get REALLY inspired at that point, perhaps my body finally GETS it!

Atkins didn't work for me, either, I think because it doesn't limit calories.

I tend to think that people who lose initial weight, then plateau "forever" has to do with two things: 1) the initial loss is a good part water and 2) the law of diminishing returns that I talked about above.

Absolutely true...the more muscle mass, the more efficiently you burn calories, which is a big reason why men have it easier than us! All that testosterone makes for muscles that burn fat very efficiently...among other things...LOL

However, when we lose weight, we don't automatically gain muscle. Diet only without exercise can make you lose weight, especially initially, but muscle isn't necessarily built, especially for women. And, as you suggest, there may be other factors that contribute due to autoimmune disease, aging (we're all doing that), those other female hormones, genetics, etc.

I just want people to know that I've struggled with this all my life, and if they never have, then they have no clue how incredibly difficult it can be.

I did gain weight, the up to 25 lbs after TT, however, I did need to gain it, I was at 88 lbs (graves/hyper).

After that I started eating better and cut out regular soda. I lost 15lbs just cutting soda out. That was 18yrs ago. Currently I am underweight for my height 5'2 and 100 lbs. I do have BAD eating habits. I do eat a lot of protein, grilled chicken, and tuna. I can not digest bread and I am lactose intolerant. Sometimes I won't eat dinner if I am alone for the evening. I hate eating alone....I do not eat breakfast, NEVER have & I do snack at work, graham crackers & peanut butter usually. I don't eat lunch, either, but that is because I hate having a time on eating, so I don't bother..

I usally eat grilled chicken, or tuna , or roast deli meat. I do crave meats. I love buffalo wings ALOT, but don't eat them all the time.

I just had a full hysterectomy almost 2 months ago. So far doing well. I actually lost 2 lbs after my 2 week follow up, but that was due to a family issue, so when I stress I don't eat...

I do go get my thyroid levels checked next week. I was put on HRT patches after the hysteretomy, so making sure no issues with the HRT & Synthorid.

I must admit I have had disagreements before, but never had anyone disagree with me from a mathematical/psychological point of view. Refreshing. LOL

The statement you said you disagreed from a mathematical/psychological point of view was this. "So when overweight due to low metabolism due to low thyroid, when thyroid levels are corrected, there should be a weight reduction to account for that." I don't understand how you could have a mathematical/psychological disagreement with that. LOL It is ironclad, since there was no specific quantification of degree of hypothyroidism or specific weight loss specified. If you are hypo and take thyroid meds and raise your metabolism, you will lose weight. Simple as that. How much? It depends.

Another point. Your said,"Say I weigh 150 lbs, and should eat 1500 calories per day to maintain my weight. I'm hypo, and while maintaining a 1500 calorie diet, I balloon up to 180 lbs, where I need roughly 1800 calories per day to maintain. I become euthyroid. My metabolism goes back to "normal". However, I religiously stick to my 1500 calorie diet. So, all other things being equal, I "save" 300 calories a day. You have to save 3600 to lose a pound, so that would be one lb every 12 days (360 days to lose the 30 lbs)." If you are 150 pounds and your Basal Metabolic Rate says you need 1500 calories per day just to stay at that weight, you are not going to "balloon" up to 180 in a short time, unless your metabolism drops drastically due to becoming hypothyroid, in which case your actual BMR would be considerably lower. And by the way "ballooning" up 30 pounds would only cause your BMR to increase by a total of 130 calories per day (30 times 4.35), not 300, over the assumed baseline.

At any rate, it seems to me that whatever amount of weight you gain over time, after becoming hypo, logically you should see about the same reduction, over a similar time period when you get your meds increased to a level that makes you euthyroid (like you were before developing hypothyroidism). So I really don't see why would it be otherwise, unless you throw in some other variables (which I mentioned and established as constants for the sake of this discussion)?

And yes, those other factors can be vital parts of the weight loss equation; however, the reason I even posted the BMR formula is to make sure hypo patients are aware that a BMR test can sometimes be useful in convincing your doctor that you have a thyroid problem, and a possible weight problem, even when your thyroid test results are all in the so-called "normal" ranges. As pointed out in a paper written by Peter Warmingham, "In hypothyroidism, on the other hand, the only measurements that are equivalent to the glucose in the insulin example, as downstream effects of thyroid hormone on the metabolic processes in the cells, are basal temperature and metabolic rate [7] measurements. However, it is more usual for [3,8,9,10] physicians treating hypothyroidism to infer that the thyroid hormone level in cells is normal from an upstream measurement—serum T/T levels. This is not a reliable inference to make because numerous mechanisms of thyroid hormone resistance can
substantially alter the relationship between the serum and cell T/T levels
3 4 as Tjorve et al. have [3] described. When the serum T/T levels are then inferred from a measurement of TSH instead of being measured directly, two levels of inference have taken place, the results of which should be treated with a high index of suspicion."

3 1/2 years ago I had RAI for graves. Before that I never really struggled with weight. I did gain 20 pounds after RAI and couldn't get it off with healthy eating and exercise. After first adding T3 meds, my weight dropped 5 lbs. After switching to Armour thyroid, going off birth control pills, I lost more. Much of it water retention.

Exercise has helped a lot. I do hot yoga or go to the gym(cardio/weights) 2-3 times a week. I also have been taking DHEA, which was low, and I feel this helped me regain the muscle tone I had lost. I take 5mg each morning, recommending by my dr. Since gaining more muscle tone, it's easier to keep my weight down.

Another thing I did to try and reset my metabolism was a detox. I cut out all alcohol, gluten, corn, soy, dairy and refined sugar for one week. No cheating. I ate a lot of homemade soups, eggs, avocados, lean proteins, veggies, coconut oil and nuts. This helped me drop the last 5 lbs. I am also always gluten free and limit dairy and soy.

"It is ironclad, since there was no specific quantification of degree of hypothyroidism or specific weight loss specified. If you are hypo and take thyroid meds and raise your metabolism, you will lose weight. Simple as that. How much? It depends."

My point exactly! The math paints a pretty bleak picture of the time line. What I'm trying to reinforce here is the idea that weight loss is SLOW, it's TEDIOUS and unless you want to spend the rest of your life doing it, you have to tip the odds a little more in your favor that just relying on being (truly) euthyroid.

Sure you weren't a politician??? LOL

"If you are 150 pounds and your Basal Metabolic Rate says you need 1500 calories per day just to stay at that weight, you are not going to "balloon" up to 180 in a short time, unless your metabolism drops drastically due to becoming hypothyroid, in which case your actual BMR would be considerably lower."

I do make the assumption that your BMR would have dropped from being hypo.

"And by the way "ballooning" up 30 pounds would only cause your BMR to increase by a total of 130 calories per day (30 times 4.35), not 300, over the assumed baseline."

I've always used a simpler (and less scientific, I suppose) calculation, but it's always worked. I assume a sedentary person needs about 10 calories/lb/day to maintain current weight. Twenty minutes of moderate exercise can increase that to 12, half an hour of vigorous exercise to 15. You calculate how many calories it would take to maintain your current weight, subtract the number of calories you eat and the difference is your "savings". Interestingly, when I did this for my current weight using your BMR formula, I was within less than a handful of calories different from doing it my way.

"At any rate, it seems to me that whatever amount of weight you gain over time, after becoming hypo, logically you should see about the same reduction, over a similar time period when you get your meds increased to a level that makes you euthyroid (like you were before developing hypothyroidism). So I really don't see why would it be otherwise, unless you throw in some other variables (which I mentioned and established as constants for the sake of this discussion)?"

No other variable thrown in. Your logic is this: You have a covered container of water half full. You add a little to that every day until it's 3/4 full. You then stop adding water, close the lid and wait for the water to get back to half a container. You're going to be waiting a loooong time unless you actively do something to take some of that water out. I can see weight stasis when euthyroid, but I'd think that you would only lose the amount gained in the same amount of time if you actually tipped the thyroid hormones slightly hypER for the same amount of time you were hypO.

Anyway, my point is still that weight loss can be extremely difficult. I think many people who never had to address it before being hypo have no appreciation for how difficult it is. There's a delicate balance between maintaining health, enthusism for the weight loss plan, a reasonable time line, etc., and if we rely on the "natural" process to bring us back to our previous weight, we are probably going to be defeated on all those fronts.

"If you are hypo and take thyroid meds and raise your metabolism, you will lose weight. Simple as that."

No, in my experience it's not as simple as that. I was really hypo, am now on med, with good levels, my metabolism is spot on. I had a BMR test, at my doctor's office, which put me within 1.5 calories of what my expected BMR (per the above formula) would be. My metabolism is just fine and I still don't lose weight.

I have lost up to 35 lbs a couple of times in my life. Once when I was in my late 30's and again, mid 40's.... none of my doctors tested thyroid function during these "gains/losses" so I don't know if they were caused by Hashi swings; I suspect they might have been.

For many, the concept of getting on adequate thyroid hormones, will do the trick; for many others, myself included, you can't discount other contributors. In my case, I have to take insulin resistance into account, along with low protein levels that cause fluid retention. My weight can fluctuate anywhere from 3-7 pounds in a 24 hr period. Of course we know that's not all "fat" weight, but where do you draw the line? When you're fluctuating on a daily basis how can you decide what your true weight is?

Then add the doctor's scale, which typically weighs 3-5 pounds higher than my scale. Which one is right? Did I somehow manage to gain 5 pounds from the time I left home until I got to my doctor's office?

I think you two have interpreted what I said as simplifying the weight issue as being only thyroid related. I did not. I know better, that's why at the very beginning, I stated, "Ignoring other possible contributors for a moment, obviously if your caloric input ( calories eaten minus calories burned with extra exercise) exceeds your BMR, then you gain weight." Thus, "when overweight due to low metabolism due to low thyroid, when thyroid levels are corrected, there should be a weight reduction to account for that." That clearly assumed that no other conditions existed that would interfere with the thyroid effect.

Obviously some hypo patients like yourselves do not find thyroid to be a big factor. Others, like myself, found it to be the whole answer for my weight gain and subsequent loss. So then, what is there to discuss, other than the percentage of patients that fall into each group, for which none of us have any facts to present, only anecdotal info.

My point from the beginning was to bring out that thyroid is potentially a significant factor in weight issues. Also, since BMR is also one of only two objective (downstream) measures of tissue thyroid levels which we all need to know about (basal body temperature is the second), I think members should be aware of its potential diagnostic value. Otherwise, we are left with subjective measures like symptoms, and upstream tests of serum thyroid levels, which are several levels of inference removed from the variable we really would like to know (actual tissue thyroid levels).

You've both added so much to this conversation. Less than hour ago I was reading an article on thyroid/weight/bmr. Loved coming here and seeing dialogue on this. I actually feel more optimistic about my ability to lose just a little bit of weight. Thank you!

Before being medicated, even with strict diet and excercise I could not get below 180 pounds. I would not "look"180 pounds though as from working out I would gain a lot of muscle and look "fit", but still very frustrating to me.

After my second pregnancy, I hovered around 207 for awhile. After dosage increase from 50mcg to 88mcg, I had more energy which allowed me to excersice 5-6 days a week (and I worked out hard, step aerobics for an hour and then and hour of weights every other day). Along with watching what I was eating (no junk food, and just not over-eating) I got down to 143 pounds for the first time since before the onset of my hypothyroid symtoms (symptoms) (in highschool).

I've recently gained back about 40 pounds (prob over a 3 month period, it was very quick). I haven't been working out as much and was being forgetful here and there in taking my synthroid, sometimes remembering to take it before bed at night (I know, bad, right?). I was getting very tired again. My doctor has increased synthroid to 100mcg,as of only about 3 weeks ago and I've been feeling better and back in the gym a little more. I'm hoping to get the 40 pounds back off, now I just need to work on my eating habits some more.

I've read through this thread numerous times and there's a lot of good information that we can take away from it.

goolarra's point of how hard it really is to lose weight; magazines, websites and TV commercials make it look so easy - they lie...... lol
gimel's point that if thyroid is the "only" cause of your weight gain, you should lose the weight once thyroid levels are adequate; it really should happen that way. Both points are valid.

While I did gain/lose 35-40 lbs a couple of times in my life, it's very possible that they were related to Hashi swings, so I probably can't put a lot of stock in those.

When I became hypo, I gained the majority of my weight in a very short time (30 lbs in < 2 months). Looking back, that was about the time I was diagnosed with Pernicious Anemia and my fasting blood sugars were consistently over the recommended level...... I also underwent 2 surgeries on my vocal cords during the same time frame, plus I worked full time and was caregiver to an elderly relative and was constantly poised for the next emergency, so my stress levels were, often, over the top - cortisol/adrenaline/insulin/hypo cocktail, anyone?

As we can see, from the various posts, there are a lot of things that can affect our weight and we all gain/lose weight differently.

While it might have sounded like I didn't think much of the BMR concept, I do, and again, that's something that I can apply to myself. As I said, I had a BMR test at my doctor's office and I just knew my BMR was going to be WAY lower than it should be, which would be why I don't lose weight, right? Wrong....... I was really hoping to use this as evidence that I might need an increase in my thyroid hormone levels. Nearly blew me away when my actual BMR was within 1.5 calories of my expected. Can't use that as excuse for an increase in thyroid med. It also proved to me, that there really are extenuating issues that need to be addressed.

What I'm seeing here is that if you've always had a hard time losing weight ("pre-hypo"), it's not going to get a lot better once thyroid levels are right. You're still going to have to work at it. But do you just have slower metabolism or do you have some other factor that's causing metabolism to be slow, such as insulin resistance or PCOS that could have been pre-hypo?

If you didn't have trouble losing weight before hypo, but do even after levels are adequate and other symptoms are gone, you might want to start looking at other causes of gain/retention.

If you didn't have a weight problem before hypo, get on med and you lose the weight; you're the lucky ones.

This whole subject area is very interesting and I hope useful for members. I'd like to throw into the mix, another angle that I had not considered until Barb reported on her BMR finding. I was so intrigued with her finding that yesterday I had a RMR test done myself. The test showed that my metabolism was "strong" as the lady described it. It was actually above the so-called "normal" for my gender, height, weight, and age.

My actual Resting Metabolic Rate was 1714 cal / day, with a predicted value for me being 1484. And of course these are not adjusted for the effect of activity level. Yet, I am still feeling somewhat hypo while in the midst of revising my meds dosage because of higher than wanted Reverse T3 levels. At first the different RMR levels were somewhat of a mystery to me. Then I recalled that the formula for calculating the so-called "normal' is heavily affected by age. The equation for estimating your predicted RMR for men adjusts downward by a factor of 6.76 calories per year.

When I did some reading on the site below, I was interested to note the quoted material below.

http://nahypothyroidism.org/is-it-your-age-or-is-it-your-thyroid/

"In elderly patients, many factors can influence TSH levels, including physiological stress, illness, or inflammation, making the TSH test inaccurate for this population. Under these conditions, tissue levels of T3, the active, energy-giving thyroid hormone, are diminished because the body inappropriately converts T4 to reverse T3, which effectively slows down the metabolism.

If you compare the symptoms of hypothyroidism with the “normal signs of aging,” you’ll see a striking similarity – neuromuscular dysfunction, depression, memory loss and cognitive impairment (feeble-mindedness), high cholesterol levels, skeletal muscle abnormalities, decreased exercise tolerance, heart disease, and deteriorating general function. Sounds a lot like symptoms of old age, doesn’t it?

Systemic illness and multiple medications often taken by senior patients for these conditions also directly affect thyroid function and reduce the accuracy of standard labs. Statin drugs used to lower cholesterol, such as Lipitor, will artificially lower the TSH.

So what can we do to correct this issue? The best tests for thyroid function in the elderly are the free T3, reverse T3 and the FT3/rT3 ratio. These tests can often provide a more accurate evaluation of thyroid hormones in the tissues, and may also predict which patients will show a favorable response to treatment with thyroid hormone supplementation.

Elderly patients with chronic health conditions who show a FT3/rT3 ratio of less than 1.8 have low tissue thyroid levels. When treated with T3 and time-released T3 (as opposed to T4 only), these patients can see significant improvement in symptoms such as fatigue, depression, weight gain and obesity, heart failure, fibromyalgia, high cholesterol levels, and other chronic conditions.

When treatment is individualized and properly monitored, these patients can enjoy improved health and a greater quality of life."

Apparently the slower metabolism with aging, and attendant symptoms, are due to falling levels of Free T3, as shown in this graph. In fact it appears that, on average, there is about a 20% drop in Free T3 from the best period of your life, to later life. This corresponds fairly well with RMR levels falling with age.

http://nahypothyroidism.org/thyroid-and-aging-graph/

So if I just accepted the result of aging and a lower Free T3 and lower RMR, then the effect would be about 290 calories less per day that I could consume. Since my Free T3 is in the upper third of the range now (and still needs some tweaking of meds), my RMR is about 230 calories above my calculated RMR for my gender, etc, but is still 60 calories per day below what it would be if I were 30 years old again. I wish.

So, for many apparent reasons, I choose to not let my Free T3 remain as low as it would be without adequate thyroid meds. I choose to be as symptom free as possible, with my RMR more reflective of being 30 than my actual age. In view of the many symptoms related to low Free T3 levels, and especially if there is a weight problem, why would we not choose to maintain optimal Free T3 levels, unless there is some yet unidentified adverse effect.of having adequate Free T3 levels later in life?

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